Appendix 11 Hospital Summary of Leukemia Case Admitted on 10-2-72 to National Cancer Institute, Hematology and Supportive Care Branch The patient is a 19-year-old man from the Marshall Islands, who transfers from the hospital of the Brookhaven National Laboratory with a tentative diagnosis of acute leukemia. PRESENT ILLNESS: This patient has been followed with yearly physicals and blood counts by the Medical Research Center of the Brookhaven National Laboratory since age one, at which time he suffered an accidental radiation exposure of 175 total body rads. He had a transient leukopenia one month following exposure but since then has had normal blood counts at his yearly examinations. At the time of a routine evaluation in August 1972, his peripheral blood white count was 1,200, platelet count 119,000, and red blood cell count 4.4 million. Attempt at a bone marrow aspiration at that time was unsuccessful, and on September 29, 1972, the patient was flown to the Brookhaven Medical Research Center for further evaluation. He had not complained of easy fatigability, spontaneous or unusual bruising or bleeding, joint or muscle aches, or an increased number of infections. At the time of admission on September 29, the hemoglobin was 12.5, white blood cell count 700 with 26% polys, 28% lymphocytes, and the remainder abnormal monocytic precursors. Urinalysis, liver function tests, and prothrobin time were all within normal limits. A bone marrow aspirate in the left posterior iliac crest was performed ° and revealed a predominance of early myeloid precursors with some dissociation of cytoplasmic and nuclear maturation and presence of Auer rods in the cytoplasm of myeloblasts. On September 30, the patient had an asymptomatic temperature elevation to 101 F. Physical examination then revealed slight injection of the pharynx and a chronically scarred left tympanic membrane. Chest x-ray was normal. Cultures were taken, and the patient was begun at that time on treatment with keflin and gentamicin. He was placed on isolation. On October 1, the patient was afebrile, and arrangements were made to transfer him here. PAST HISTORY: Operations: Subtotal thyroidectomy. Accidents: None Medicines: Occasional "Anacin" tablet; synthroid, 0.3 mg. daily from 1968 until May 1972, FAMILY HISTORY: Mother, father, six brothers, and three sisters are all living and in good health in the Marshall Islands. -1THE CUNICAL CENTER NATIONALINSTITUTES OF HEALTH ~ 140 - oonoW CLINICAL RECORD Rongelap (54) 09-44-40 3 Mistery end Physica! Examinetion Summery Consultation Follew-wp Comtinvation WIM-999 (Rev. 5-71)